From posthumous-assisted reproduction to early sperm preservation: Israeli men's perspectives on reproductive decision-making.

RESEARCH QUESTION: During a time of armed conflict and rising posthumous sperm retrievals in Israel, what are Israeli Jewish men's attitudes toward elective sperm preservation and posthumous-assisted reproduction (PAR), and which motivations and sociodemographic factors are associated with these attitudes? DESIGN: A cross-sectional study of 402 Israeli Hebrew-speaking Jewish men (ages 18-40 years) was conducted between 2025 and 2026. The questionnaire assessed demographics, role in the conflict and attitudes toward sperm preservation and PAR. Multivariable logistic regression analysis was used to assess factors associated with willingness to preserve spermatozoa and PAR. RESULTS: Overall, 41.5% of participants expressed willingness to preserve their spermatozoa, with significantly higher willingness among men without biological children and those without living parents. Both factors remained independently associated with willingness in multivariable analysis (lack of biological children: aOR 4.4, 95% CI 2.3 to 8.6; no living parents: aOR 2.1, 95% CI 1.2 to 3.8). No significant associations were found with age, socioeconomic status or religiosity. Primary motivation was concern about future infertility and potential disease, with limited willingness to pay. Although preservation support was significantly associated with PAR approval, only attitudes toward PAR were significantly associated with religiosity. CONCLUSION: Sperm preservation is viewed primarily as 'fertility insurance' for life rather than posthumous continuity. This challenges assumptions of 'presumed consent' for genetic legacy and supports pre-documentation of reproductive preferences, particularly during military recruitment. A shift to a proactive, consent-based model may better respect autonomy and reduce the ethical and psychological burden on bereaved families.